Patient Navigator in Santa Clarita, CA at Quest Diagnostics

Date Posted: 6/11/2022

Job Snapshot

Job Description

Patient Navigator - Valencia, CA - Monday-Friday 8:00am - 4:30pm

Job Summary

Obtains and manages any required documentation (as required by state or other regulatory entities for designated testing) to determine preauthorization, informed consent requirements and other requirements from a variety of insurance plans, payers and governing sources.  Handles all payer, physician and patient contact.  Troubleshoots both complex medical/technical compliance and routine requests. Partner with Health Plans team to drive resolution on challenges with regards to pre-authorization and denials. 

Job Accountabilities

•            Ability to perform all tasks of a Special Testing Services Coordinator.

•            Handles client, sales, and patient inquiries regarding preauthorization and billing.

•            Responds to patient complaints and assures appropriate action for resolution occurs.  Handle sensitive and escalated client and patient interactions.

•            Assists in documenting standard operating procedures for the Department.

•            Provides input and guidance to staff members in order to ensure continuous improvement in processes which will improve customer service.

•            Works with Compliance to report and resolve any billing compliance concerns.

•            Supports billing teams by providing guidance with regards to facilitating appeals in order to maximize reimbursement experience.  Provides training to billing teams on pre-authorization systems. 

•            Researches denial concerns and reports to management and billing teams in order to foster a bridge between pre-authorization and billing. Identifies and escalates reimbursement and denials issues and potential resolution techniques to management and billing teams.

•            Coordinates testing in parallel to obtaining proper documentation to comply with all payer requirements.

•            Documents reporting or call history in the patient file and maintains appropriate records. Also documents tools for pre-authorization team and billing teams in the form of job aids and databases which warehouse payer and process information.

•            Support Health Plans team by articulating where their support is necessary, in order to drive improvements in pre-authorization process or reducing denials and write offs. 

•            Recognizes quality service issues and provide feedback to appropriate personnel on opportunities for improvement.

•            Has ongoing responsibility for maximizing department quality and productivity by monitoring service levels and minimizing abandoned calls by supporting the phone queue.

•            Other duties as required of the designated ”senior” in the department.

Job Requirement:

•            Bachelor’s degree preferred, related work experience considered in lieu of a degree.

•            Medical billing experience preferred; understanding of medical terminology required.

Competencies:

  • Comfort around higher management (lab manages, medical professionals, health plan agents)
  • Problem Solving
  • Customer Focus
  • Priority Setting
  • Perseverance
  • Action oriented
  • Informing

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